J Korean Ophthalmol Soc.  2017 Feb;58(2):230-234. 10.3341/jkos.2017.58.2.230.

Pigmented Mass in the Anterior Chamber Suspected of Granuloma Caused by a Metallic Foreign Body

• Park MS
• Choi SY
• Lee SM

• KMID: 2369475
• DOI: http://doi.org/10.3341/jkos.2017.58.2.230

Abstract

PURPOSE
To report on a patient with a brown pigmented mass in the anterior chamber suspected of a granuloma caused by a metallic foreign body and to review the relevant literature.
CASE SUMMARY
A 63-year-old man presented with blurring in his right eye, which had initially began several years prior. Concentric corneoscleral brown pigmentation about 2 mm in diameter was found in the superonasal limbal area. A rectangular parallelepiped mass was observed in the superonasal anterior chamber, which was an even brown color with a small white portion, smooth-surfaced, and non-vascularized. The pupil was oval and dragged superonasally, possibly due to mild compression of the iris caused by the mass. In pre-enhanced orbital computed tomography, a round high signal intensity with a diameter of 3.0 mm was found in the superonasal anterior segment. Though excisional biopsy using the lamellar scleral flap was considered for exact diagnosis, this was not performed considering the clinical features are more indicative of granuloma than iris melanoma. Neither changes in the size of the mass nor the shape of the pupil were observed during the follow up period until 19 months after the first visit.
CONCLUSIONS
When a pigmented mass in the anterior chamber is detected, benign and malignant iris tumors and granulomas should be considered for a differential diagnosis. The patient's exact past medical history and clinical features differentiating malignant and benign masses are important for proper diagnosis due to the difficulty in obtaining tissue diagnoses in some cases.

Keyword

Foreign body; Granuloma; Iris tumor; Melanoma; Metal

MeSH Terms

Anterior Chamber*
Biopsy
Diagnosis
Diagnosis, Differential
Follow-Up Studies
Foreign Bodies*
Granuloma*
Humans
Iris
Melanoma
Middle Aged
Orbit
Pigmentation
Pupil

Figure

• 

  Figure 1. Slit lamp examination of the patient. (A) Slit-lamp examination revealed oval shaped pupil (arrow) drawn to superonasally and brown pigmentation (arrowhead) on the superonasal peripheral cornea, which is concentric and centered on a limbal point. (B, C) The superonasal pigmentation consists of two layers, of which the superficial layer was located in the anterior stromal level with diameter of 1 mm (arrows) and the deep layer was in the posterior stromal level with diameter of 2 mm (arrowheads). (D) Gonioscopy visualized rectangular parallelepiped mass (2 mm wide × 0.6 mm height × 0.3 mm depth, arrow) in the superonasal anterior chamber. The mass consists of a mainly even-brown-colored double-hump-shaped portion and a small white portion be-tween the two humps. The surface of the mass was smooth and non-vascularized.

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  Figure 2. Anterior segment optical coherence tomography of the patient. The red circle showed two-layered separate in-creased density in the anterior stroma and posterior stroma in-cluding endothelium. A mass with increased density originates from the posterior stroma and endothelium of the cornea. However, the mass area inside the anterior chamber, which was observed by gonioscopy, was not visualized by anterior segment optical coherence tomography possibly due to the rapid signal attenuation of the light by the mass. The dotted line simulates imaginary outline of the mass considering the shape of the mass seen by gonioscopy.

• 

  Figure 3. Orbital computed tomography of the patient. It showed high signal intensity in the superonasal anterior seg-ment of the right eye (arrow). The mass was symmetrically round with a diameter of 3.0 mm and its average radiodensity was about 774 Hounsfield unit.

Reference

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